terça-feira, 2 de dezembro de 2008

Demitir Jack Bauer, acabar com a tortura

Futuro Presidente dos EUA, Barack Obama: demissão sumária de Jack Bauer.
Secretário dos Direitos Humanos, Paulo de Tarso Vanucchi: menos bravatas em auditórios com ar condicionado e caça aos Jack Bauers tupiniquins.
Who is Jack Bauer? Dr Homer Drae Venters MD (publicado no The Lancet)
A patient of mine, Kofi, once asked me, “Who is Jack Bauer?” I felt a little queasy because the patient, question, and answer all shared a common element, torture. I first met Kofi when I was a resident, only 1 year into my training in assessing survivors of torture who were seeking asylum at the Bronx Human Rights Clinic, New York, USA. The application of these people can be strengthened by medical examination of the physical and mental sequelae of torture. Before fleeing his country, Kofi endured several brutal detentions, as part of government persecution of his ethnic group. During his assessment at the Bronx Human Rights Clinic, Kofi described in detail the beatings, stabbings, and various humiliations that his government had perpetrated on him. Kofi then underwent a laborious 3-h physical examination, cataloguing every scar and musculoskeletal and neurological finding. The final part of this examination was to assess Kofi's psyche for the inevitable consequences of his experiences. Several months later, Kofi's asylum application was granted; we have continued to see each other for his primary-care needs. So what of Jack Bauer?
Kofi has taken a deep interest in the politics of his adopted country, and has watched every US presidential debate so far. During one debate, a scenario was put to all the candidates, that can be summed up as the torture dilemma: terrorists have struck on US soil; the authorities have detained suspects, and have reason to think that some may possess knowledge of another imminent attack. The presidential candidates were asked whether to torture or not to torture. Only one candidate, Senator John McCain of Arizona, unequivocally responded in the negative; the others advocated various forms of so-called enhanced interrogation: a phrase which gives torture a more palatable label, and perpetuates the false impression that torture enhances interrogation. The most popular and memorable response came from Representative Tom Tancredo of Colorado, who responded: “I'm looking for Jack Bauer at that time, let me tell you”.
Jack Bauer is the immensely popular character from the Fox TV show 24, who regularly relies on his own version of enhanced interrogation. Jack Bauer makes torture popular.
Somewhere in the fog of war, terror, and politics, we have become accustomed to the idea of torture. Recent polling shows that American acceptance of torture is increasing, from 36% in 2006 to 44% in 2008.
Additionally, more than half of Americans support torture in some situations, and an equal number support the practice of so-called rendition to other countries for the purpose of torture.During prime-time television, this approval of torture is generated and reflected by Jack Bauer, roughing up prisoners in a weekly struggle to protect the country. As I chatted with Kofi about how we arrived at this acceptance of torture in the USA, he said, “You have no idea what you would do to your neighbour if you thought he would harm your family.” Kofi went on to explain that acceptance of torture can arise from a heightened level of fear, that overcomes good judgment and gives way to inhumanity. For him, tribal fears and animosities paved the way for his persecution. For Americans, Kofi observed, a toxic fear of terror has allowed torture to emerge as an accepted practice.
A central argument against torture is exemplified by Senator John McCain's belief that torture is inherently un-American. Senator McCain believes that to torture is to debase our national identity. George Washington, as a general in the American War for Independence, observed British troops executing surrendered American prisoners, and banned any retaliation in kind, stating: “Treat them with humanity, and let them have no reason to complain of our copying the brutal example of the British Army in their treatment of our unfortunate brethren”.
4 In torturing, even out of fear for our survival, we lose our virtue and identity as a nation. Virtually every US president since George Washington has endorsed his rebuttal of torture as un-American, as has President-elect Senator Barack Obama. If we cannot torture because of who we are, the damning question then becomes: who have we become if we accept torture? The use of torture undoubtedly has consequences for the external identity of a nation as well. Referring to revelations of torture by US forces in Iraq, historian Alfred McCoy writes that it has “subtly subverted American rhetoric about democracy and has damaged the nation's moral leadership in the Middle East”.5 The use of torture by US forces was not new;6 but the photographs from Abu Ghraib in Iraq forced people to ask if systematic use of torture was consistent with the ideals of democracy and freedom.
A second critique of torture is that it simply does not work. Torture apologists often appeal to a desire to get tough, and the reported need to increase the amount of information extracted from so-called high-value detainees. Without widespread understanding of the ineffectiveness of torture, the debate often devolves into duel by anecdotes. But analysis of interrogations has shown torture to be ineffective. One of the most successful US interrogators during World War 2, Marine Corps Major Sherwood Moran, eschewed torture as counterproductive. During interrogations of Japanese prisoners, Moran observed that brutality “played right into the hands of those who were determined not to give away anything of military importance”. By contrast, Moran's success was based on the approach to “forget, as it were, the ‘enemy’ stuff, and the ‘prisoner’ stuff. I tell them to forget it, telling them I am talking as a human being to a human being”.
After World War 2, the US Military Intelligence Field manual was updated to state that the USA “prohibits the use of coercive techniques because they produce low quality intelligence. The use of force is a poor technique as it yields unreliable results, may damage subsequent collection efforts, and can induce the source to say whatever he thinks the interrogator wants to hear”. A 2006 report by the National Defense Intelligence College reviewed all available evidence on interrogation techniques and concluded “…studies of the role of assault in promoting attitude change and in eliciting [false] confessions revealed that it was ineffective. Belief changes and compliance were more likely when physical abuse was minimal or absent…although pain is commonly assumed to facilitate compliance, there is no available scientific or systematic research to suggest that coercion can, will, or has provided accurate useful information from otherwise uncooperative sources”. In his book, Torture and the Ticking Bomb, Robert Brecher further deconstructs the usefulness of torture, particularly in the type of scenario presented in the debate watched by Kofi. Brecher concludes that in matters of extreme urgency or importance, a nation would be ill-served to turn to the least reliable method of interrogation.
These two arguments against torture, though compelling, still fall flat when I think of Kofi. Each of these criticisms addresses a larger context: our national identity and our national security. However, the most abhorrent aspect of torture is what Kofi and other survivors of torture often reveal to their physicians. That one human being picked up a knife and cut into another. Or suspended them from the ceiling while they were beaten. Or raped them. Or burned them. Long after his scars healed and he adjusted to the aches in his joints, Kofi has continued to struggle with mental anguish from being tortured. We are tempted by the glamour and raw charisma that we project onto Jack Bauer, the illusion of protection, and the lure of vigilante justice. But the raw truth of torture is that whatever the original motive, the torturer and the tortured are transformed into a perpetrator and a victim of violence. The torturer visits inhumanity on his victim, but also on himself and the surrounding community. Athar Yawar notes the relation between the use of torture and the inexorable decay of social fabric, as cruelty and inhumanity becomes pervasive and normative.
In an analysis of state tyranny, Riadh Abed similarly observes that the dehumanisation of the individual torturer and the acceptance of his acts “leads to the erosion of accepted social norms of behavior and the normalization of violence”.
As physicians, we have a responsibility to oppose torture. We treat many patients who describe torture, and many more who have experienced it, but cannot bring themselves to disclose it. If Kofi is correct that irrational, overwhelming fear can lead to inhumanity, we should stoke the fires of reason. Three areas for intervention exist for us as physicians. First, we can educate ourselves (as students, residents, and attending physicians) about torture as a public-health issue, its prevalence in our patient populations, and how it affects our ability to deliver care. In recognising torture as a form of violence affecting many of our patients, we can develop standards of screening, medical education, and patient information that facilitate good medicine. When physicians become more knowledgeable about the effects and prevalence of torture, we can begin to detect and, when necessary, treat the adverse effects of torture among our patients. Second, we should strengthen ties with human-rights organisations, lending the credibility and resources of our profession to this endeavour. Just as physicians eventually became integral to campaigns against child abuse and intimate-partner violence, we should now join the international effort against torture. In their landmark report, Medicine Betrayed, the British Medical Association stated that physicians who are aware of torture “have a positive obligation to make those activities known”.
Finally, we should proceed in the least partisan manner possible. The political nature of torture is inescapable. But we will need to cast this discussion in terms of violence, public health, and our ability to deliver medical care to our patients. By bearing witness to the brutality visited on Kofi and others, we may be able to care for our patients better, while helping to eliminate public acceptance of torture.

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